Periprosthetic Femur Fracture T84.049A 996.44

ICD-9 Classification / Treatment
Etiology / Epidemiology / Natural History Associated Injuries / Differential Diagnosis
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References


Periprosthetic Femur Fracture ICD-10

A- initial encounter

D- subsequent encounter

S- sequela

Periprosthetic Femur Fracture ICD-9

Periprosthetic Femur Fracture Etiology / Epidemiology / Natural History

  • 996.41 mechanical loosening of prosthetic joint
  • 996.44 peri-prosthetic fracture around prosthetic joint 
  • 996.45 periprosthetic osteolysis

Periprosthetic Femur Fracture Anatomy


Periprosthetic Femur Fracture Clinical Evaluation


Periprosthetic Femur Fracture Xray / Diagnositc Tests

  • Consider ESR and CRP.  11% of periprosthetic fractures have concomitant infection.  (Chevillotte CJ, Ali MH, Trousdale RT, Larson DR, Gullerud RE, Berry DJ. Inflammatory laboratory markers in periprosthetic hip fractures. J Arthroplasty. 2009 Aug;24(5):722-7)

Periprosthetic Femur Fracture Classification / Treatment

  •  Vancouver classification
  • Type A=proximal to prosthesis (trochanteric region_:
  • Type B1=fracture around the stem or at the tip of the stem with component solidly fixed.
    -Treatment=plating vs allograft strut
  • Type B2=femor fracture around or just distal to a loose stem with adequate proximal bone stock.
    -Treatment= revision with long porous-coated cylindrical stem.
  • Type B3=femor fracture around or just distal to a loose stem with poor proxmial bone
    -Treatment: revision to long stem prosthesis +/- bone grafting/strutt. Consider proximal femoral replacement for elderly inactive patients. (Klein GR, JBJS 2005;87Am:1777).
  • Type C=distal to prosthesis, treated independently
  • Lateral locked plating with indirect reduction (Ricci WM, JOT 2006;20:190).
  • Time to surgery for periprosthetic fracture  >24 hours has higher rates of overall complications, urinary tract infections, non-home discharge, blood transfusions and longer length of stay.  No statistical difference in mortality compared to ≤24 hours. (Boddapati V, J of Arthroplasty 2019)
  • Age >70 with poor bone quality who require early mobilization = distal femur arthroplasty.
  • Periprosthetic supracondylar femoral fractures:  treatment options include conservative care,  retrograde intramedullary femoral nail,  locked or unlocked femoral plate, revision TKA. 

Periprosthetic Femur Fracture Associated Injuries / Differential Diagnosis


Periprosthetic Femur Fracture Complications


Periprosthetic Femur Fracture Follow-up Care


Periprosthetic Femur Fracture Review References

  • Duncan CP, ICL 1995;44:293
  • Parvizi J, JBJS 2004;86A:8
  • Younger AS, ICL 1998;74:251
  • Lee SR, ICL 2004;53:111
  • Ristevski B, Nauth A, Williams DS, Hall JA, Whelan DB, Bhandari M, Schemitsch EH. Systematic review of the treatment of periprosthetic distal femur fractures. J Orthop Trauma. 2014 May;28(5):307-12.
  • Saidi K, Ben-Lulu O, Tsuji M, Safir O, Gross AE, Backstein D. Supracondylar periprosthetic fractures of the knee in the elderly patients: a comparison of treatment using allograft-implant composites, standard revision components, distal femoral replacement prosthesis. J Arthroplasty. 2014 Jan;29(1):110-4.
  • Chen AF, Choi LE, Colman MW, Goodman MA, Crossett LS, Tarkin IS, McGough RL. Primary versus secondary distal femoral arthroplasty for treatment of total knee arthroplasty periprosthetic femur fractures. J Arthroplasty. 2013 Oct;28(9):1580-4.
  • Thompson SM, Lindisfarne EA, Bradley N, Solan M. Periprosthetic supracondylar femoral fractures above a total knee replacement: compatibility guide for fixation with a retrograde intramedullary nail. J Arthroplasty. 2014 Aug;29(8):1639-41 
  • Service B, Kang W, Turnbull N, Langford J, Haidukewych G, Koval KJ. The Influence of Femoral Component Design on Retrograde Femoral Nail Starting Point. J Orthop Trauma. 2015 Apr 28.